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Reports estimate that 25,000 Americans suffer from an ankle sprain each day. Ankle sprains
account for almost half of all sports injuries and are a common reason why athletes take time off
from activities. Accurate diagnosis is critical, as some studies suggest that 40 percent of ankle
sprains are misdiagnosed or poorly treated leading to chronic ankle pain and disability. Self-
education is therefore important in order to decrease the risk of this disabling complication.
Common Causes
More than 80 percent of ankle sprains are a result of inversion, or inward rolling, of the ankle.
This is commonly experienced in athletic activities that involve running, pivoting and jumping.
While sudden, forceful movements are certainly the cause of many ankle sprains, low-grade
repetitive trauma can also weaken and injure ankle ligaments. Risk factors for ankle sprains
include previous ankle injury, impaired balance/postural control, type of sport played, position,
and muscle strength/range-of-motion deficits. Excess body weight may also be a risk factor for
males.
Grade I: The most common type; these are associated with a mild degree of swelling
and pain related to stretching of the ligament.
Grade II: More commonly seen in athletic injuries, these are associated with a moderate
degree of swelling and pain and are related to an incomplete tear of the ligaments.
Grade III: The most severe of ankle sprains; these are associated with significant
swelling and pain and are related to complete tear of the ligaments.
Prognosis is directly related to the severity of injury. Immediate evaluation and treatment will
often lead to an increased chance of complete recovery. Surgery is rarely necessary, as most
ankle sprains will heal with conservative management.
Rehabilitation
A comprehensive rehabilitation program is a critical part in the treatment of ankle sprains. With
the guidance of an experienced physical therapist or athletic trainer, stretching and
strengthening of the ankle joint and calf muscles will quicken the recovery time and decrease
the risk of re-injury. To maintain cardiorespiratory fitness during recovery,walking or jogging in a
pool or cycling is recommended, as the weight on the ankle is decreased. Re-training the
muscle sensation (called proprioception) and postural control (balance) should be a critical
component of any rehabilitation program. Balance training, using ‘wobble boards’, is an
excellent rehabilitation technique that helps strengthen and stabilize the ankle, reducing the risk
of re-injury. Returning to activities usually varies from a few days to two months, depending on
the severity of injury.
Prevention of Re-Injury
Prevention in athletics is an important matter to discuss with a skilled sports medicine
practitioner. Properly applied external ankle supports (tape, semi-rigid, and rigid braces) and
balance board exercise training can reduce the risk of ankle re-injury by more than 50%. These
prevention strategies are especially effective for those with a history of a previous ankle injury.
External ankle supports do not adversely affect athletic performance. Semi-rigid and rigid ankle
supports are most effective, widely available, and cost less than athletic tape.
Summary
Ankle sprains are one of the most common injuries in the athlete. Accurate and rapid diagnosis,
comprehensive treatment, and rehabilitation are critical in reducing the risk of re-injury or
chronic disabling ankle pain. Prevention of injury should be a part of any training and exercise
plan. The ultimate goal of any treatment program is to improve function without inhibiting the
athlete’s performance.
Written for the American College of Sports Medicine by Victor Ibrahim, M.D., Zinovy Meyler,
D.O., and Andre Panagos, M.D.
ACSM Current Comment